Pregnant Women Are Wondering: Should I Have a Home Birth?
The Covid-19 pandemic is
causing additional panic for expectant mothers, who no longer know if a
hospital is the best place for them.
“Until now, I had never imagined giving birth
anywhere other than a hospital,” says the 28-year-old, 25-week-pregnant
Crystal Holstine. “But I have recently been considering looking into
home birth options, so we aren’t exposed to [Covid-19] as much and I
know that my support system can be there for the process.” As her
pregnancy and the coronavirus crisis progress, Holstine is feeling
increasingly uncertain about what labor and delivery will look like in
the midst of a global pandemic that has strained an already flawed U.S.
healthcare system.
“The virus has increased my
anxiety about attending [prenatal] appointments, [because of] the risk
of being exposed to the coronavirus, and putting me and my son in
danger,” says the Knoxville, Tennessee, resident. “I am afraid of
catching the virus. I am afraid of passing it on to my baby. I am
worried about what delivery might look like if the protocols haven’t
lifted. Like: Will my significant other be allowed in the room? Can our close family visit us? I am afraid of being separated from my baby after birth because of the virus.”
Holstine is not alone. More and more pregnant women are considering at-home births
in response to coronavirus-related changes in hospital visitor
policies. In New York City, two leading hospital networks banned partners or support people from delivery rooms
in order to mitigate the spread of Covid-19; after the directive
received backlash from expectant parents, doulas, and midwives, Governor Andrew Cuomo issued an executive order
requiring all hospitals to allow one support person in the labor and
delivery room. (According to the World Health Organization, care is needed throughout and directly following childbirth,
which includes having a companion of choice present during labor and
delivery.) The order did not require hospitals to allow any additional
support people, however, so if a laboring woman's partner is her one
support person, a doula, friend, or other family member would not be
allowed to attend the birth.
It is the prospect of potentially giving birth
alone or without a desired support team, in addition to the fear of the
virus itself—which may affect pregnant people in more severe ways and could be passed along to their babies—that has led to an increase in anxiety among pregnant women. Since there’s a possibility that moms who test positive for coronavirus could be separated from their babies at birth, leading to potentially negative impacts for both mother and baby, those anxieties are only mounting.
“I
have many patients who’re feeling incredibly anxious and
discombobulated because they’re pregnant and they’re navigating this
incredibly uncertain time,” Dr. Carly Snyder, a reproductive and
perinatal psychiatrist practicing in New York City, tells Marie Claire.
“Every single one of us is sitting at home, hopefully, socially
distancing ourselves, and feeling very, very vulnerable. But the
pregnant women amongst us have this additional layer of uncertainty that
is just... it’s a level that supersedes the rest of us, and for
understandable reasons.”
Like Snyder, I am a
psychologist specializing in women’s reproductive and maternal mental
health and have also received an increase in the number of pregnant
patients requesting emergency sessions to discuss their anxieties
surrounding pregnancy and childbirth. Some are due to give birth in the
immediate future, while others have months to prepare for delivery and
the ways in which it could be potentially altered by this ongoing public
health crisis. But how close or far away a person’s due date is doesn’t
necessarily correspond to how anxious they are about the prospect of
giving birth, or how they respond to that anxiety.
For
Jeanie McDowell, 29, from Charlotte, North Carolina, staying up-to-date
on her hospital’s Covid-19 response policies is helping her remain
grounded. “I’m lucky enough to not live in any of the areas hardest hit
by Covid-19, so my hospital’s restrictions aren’t nearly as strict as
they are in other parts of the country,” she says. “As of today, we’re
allowed one support person and one partner, and my plan is to just have
my husband come with me.”
Many hospitals are not allowing visitors of
any kind for any treatments or procedures, unless there are imminent
end-of-life implications. According to New York-Presbyterian's website,
visitors are not allowed in postpartum units, and only one visitor per
pediatric patient is permitted in the NICU. “I hate that our families
won’t be able to meet our son in the hospital,” says McDowell, “but I’m
also looking forward to having some privacy and to being able to adjust
to being a family of three.”
Thirty-seven weeks
pregnant with her first child, McDowell does feel somewhat cheated by
the ramifications of the virus. “My hospital canceled all hospital
tours, labor and delivery classes, and breastfeeding classes,” she says.
“As a first-time mom, it’s definitely nerve-wracking. While I’ve done
my best to research and get my information from friends, at my OB-GYN
appointments, or online, I still feel like I’m not as prepared as I
should be.”
Still, she isn’t changing her birth
plan or deciding to birth at home—a decision that Nuranisa Rae, a
certified nurse midwife and owner of Nur Midwifery
in New York, considers wise. “To come to [home birth] at the end of the
game, because there’s this fear and now you want to know what your
options are, doesn’t necessarily make you a good candidate for home
birth,” she says.
In the aftermath of the
initial directive banning partners from labor and delivery rooms, Rae
was bombarded by soon-to-be moms hoping to have home births so they can
be supported. (“Just today I received 15 emails, despite the fact that
we’re all posting on our social medias that we’re not taking people.”)
But finding a certified nurse midwife to assist an at-home birth only a
month or two out from your due date isn’t feasible, she says, in part
because a home birth requires months of mental, physical, emotional, and
often spiritual preparation. Home births require a level of trust
between the expectant mom and her midwife—trust that can take time to
cultivate. “I don’t discourage women from reaching out, but I think that
they first need to educate themselves as to what they’re getting
themselves into.”
Sakina O’Uhuru, executive director of Gentle Spirit Home Birth Midwifery Services
in New York, who has been a midwife for 20 years, agrees. She is also
receiving between 10 and 20 calls a day from expectant moms seeking to
severely alter their birth plans. She is encouraging them to consider
the feelings behind that desire.
“It is extremely important to explore the fear that
is driving this decision, as well as the fear that led to the original
decision for a hospital birth,” she tells Marie Claire. If a
soon-to-be mom goes into a home birth afraid or convinced she is not
safe, O'Uhuru says, her mindset could have a negative impact on her
overall labor and delivery experience. Her motto for parents thinking
about changing their birth setting “is to understand that they must be
able to commit to this decision 150 percent.”
“If [a mom’s] reason for wanting to have a
hospital birth was because she wanted to have an epidural, for example,
then she should remain connected to her original decision,” says
O'Uhuru.
Instead of preparing patients to
drastically alter a birth plan so close to a due date, Snyder, the
reproductive psychiatrist, is counseling them: talking through the
reasons why these mandates are put in place; legitimizing their feelings
of anger, fear, isolation, and resentment; and minimizing any other
potential unknowns. Some practical actions—like utilizing FaceTime in
the delivery room, making sure all the necessary chargers are in your
hospital go-bag, and meeting every OB-GYN in the practice via FaceTime,
if possible—can help create a new birth plan that gives you a sense of
control.
“While it’s unexpected and scary,
you’re still in the same scenario: You’re still having a baby,” Snyder
says. “So I’m working to empower my patients to realize that they can
rise to the occasion. That this is still their story. They're still
about to have a baby, and that’s a wonderful thing, right?" Snyder says
that those who cannot be physically in attendance during the birth can
still be virtually present, and the same goes for postpartum visitors—a
new mom might not be able to show off her baby in person, but she can
still show her baby off. "This does not have to be about a negative."
If
a pregnant person can find a certified nurse midwife to assist them in a
somewhat-immediate (i.e. in the next month or two) home birth, Rae says
there are a few ways they can prepare. “If women are making this very
sharp change in their plans and they found a midwife who’s willing to
help them, their whole self really has to be dedicated to this,” she
explains. “You really have to be pushing out the outside world, not
watching all the Covid-19 updates. Instead, watch lots of documentaries
about home birth, read positive birth stories, and have a strong
understanding of how your body works and submitting to that.”
And
for those women who are in their first or second trimester, Snyder
recommends they do not focus on a future that is impossible to predict
and, instead, use this time to slow down. “We, as a society, as people,
are incredibly rushed. We are hardwired to always be doing something; to
be over-scheduled and overworked. And the only blessing of this
unfathomable pandemic is that we’re being forced not to be
over-scheduled because we have to be home,” she says. “Use this time as
an opportunity to do things that you’d like to do, but that you always
feel like you don’t have the opportunity to do. Because in reality, once
you have a baby, life really does change.”
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